Improving the management of the child with an unexplained limp

A clinical governance project is set up following the delayed diagnosis of two children with life‐threatening conditions (osteomyelitis and Ewing's sarcoma). They attended A&E with a simple limp. The aim is to improve the management of this very common presentation. With this purpose, a series of algorithms was created and then its use with a prospective study assessed

The study was carried out for nine months. A total of 113 children were included in it. Some 65 per cent were diagnosed, treated and followed up by the A&E department exclusively. Only 15 per cent required hospital admission. No hip aspirations were required to diagnose septic arthritis, as the exclusion of this condition was based on the four predicting factors (pyrexia, raised WCC, raised PV and CRP and fluid in the hip joint demonstrated by hip ultrasound).

It is believed that the management of this group of children is greatly improved.

The protocol presented in this study is cost‐effective as unnecessary hospital admissions are avoided, fewer patients are referred to specialised clinics and appropriate use of the radiology service is made out of hours. Diagnosis and treatment of serious conditions such as septic arthritis, or Perthe's disease, does not get delayed.